PAP SMEAR

 Papanicolaou smear 

Papanicolaou smear (Pap smear, cervical smear) is a safe, noninvasive cytological examination for early detection of cervical cancer. During the 1900s, cervical cancer was one of the leading causes of death among women. It was until the year 1928, where a greek physician George Nicholas Papanicolaou was able to discover the difference between normal and malignant cervical cells by viewing the samples microscopically, hence Pap smear was invented.

INDICATIONS OF PAP SMEAR

• To detect malignant cells.

• To detect inflammatory changes in tissue.

• To assess response to chemotherapy and radiation therapy.

• To detect viral, fungal, and occasionally, parasitic invasions.

PAP SMEAR PROCEDURE

Pap smear is performed by a practitioner and takes approximately about 5 to 10 minutes. The step-by-step procedure is as follows:

The patient is positioned.
The client is assisted in a supine, dorsal lithotomy position with feet in stirrups.

A Vaginal speculum is inserted.
The practitioner don gloves and inserts an unlubricated plastic or metal speculum into the vagina and is opened gently to spread apart the vagina to access the cervix. The speculum may be moistened with saline solution or warm water to make insertion easier.

Cervical and vaginal specimens collection.
After positioning the speculum, a specimen from the vagina and cervix is taken. A cytobrush is inserted inside the cervix and rolls it firmly into the endocervical canal. The brush is then rotated one turn and removed. A plastic or wooden spatula is utilized to scrape the outer opening of the cervix and vaginal wall.

Collection technique.
The specimen from the brush and spatula is wiped on the slide and fixed immediately by immersing the slide in equal parts of 95% ethanol or by using a spray fixative.

Collection technique (Using the ThinPrep collection).
The brush and spatula are immediately immersed in a ThinPrep solution with a swirling motion to release the material. The brush and spatula are then removed from the solution and the bottle lid is replaced and secured.

Label the specimen
The slides are properly labeled with the patient’s name, age, initials of the health care provider collecting the specimen, date, and time of collection.

specimens are sent to the laboratory
The specimens are transported to the laboratory for cytologic analysis.

A bimanual examination may follow.
After the removal of the speculum, a bimanual examination may be performed wherein the health care provider will insert two fingers of one hand inside the vaginal canal to feel the uterus and ovaries with the other hand on top of the abdomen.

Before the procedure

Secure patient’s consent. The test must be adequately explained and understood by the patient before a written, and informed consent is obtained.

Obtain the patient’s health history. These include parity, date of last menstrual period, surgical status, contraceptive use, history of vaginal bleeding, history of previous Pap smears, and history of radiation or chemotherapy.

Ask lists of the patient’s current medications. If a patient is taking a vaginal antibiotic, the pap smear is delayed for one month after the treatment has been completed.

Explain that Pap smear is painless. The test requires that the cervix may be scraped and may experience minimal discomfort but no pain from the insertion of the speculum.

Avoid interfering factors. Having sexual intercourse within 24 hours, douching within 48 hours, using a tampon, or applying vaginal creams or lotions is avoided before the test since it can wash away cellular deposits and change the ph of the vagina.

Empty the bladder. Pap smear involves the insertion of the speculum into the vagina and could press down the lower abdomen.

After the procedure

The nurse should note the following nursing interventions after pap smear:

Cleanse the perineal area. Secretions or excess lubricant from the vagina are removed and cleansed.

Provide a sanitary pad. Slight spotting may occur after the pap smear.

Provide information about the recommended frequency of screening. The American Cancer Society recommends screening every three years for women aged 21 to 29 years old and co-testing for HPV and cytological screening every five years for women aged 30 to 65 years old.

Answer any questions or fears by the patient or family. Anxiety-related to the pending test results may occur. A discussion of the implications of abnormal test results on the patient’s lifestyle may be provided to the patient.

FINDINGS(Results)

The Bethesda System (TBS) is the current method for interpreting cervical cytology and it includes the following components.

Normal findings in a Pap smear will indicate a negative result which means that no abnormal, malignant cells or atypical cells are found. While a positive result signifies that there are abnormal or unusual cells discovered, it is not synonymous to having cervical cancer

Normal Results

• No malignant cells or abnormalities are present.

Abnormal Results

• Cells with relatively large nuclei, only small amounts of cytoplasm, abnormal nuclear chromatin patterns, and marked variation in size, shape, and staining properties, with prominent nucleoli, suggest malignancy.

• Atypical but nonmalignant cells suggest a benign abnormality.

• Atypical cells may suggest dysplasia.